Sometimes it seems like the healthCARE industry is more like a healthWON’T industry. Why do we always have to color within their lines when everyone’s situation is different? I don’t get it.
If the insurance company wants me to NOT have to buy medication, why don’t they let the doctor prescribe me something that could help me without causing me to be a lifelong dependent of a drug that THEY would have to pay for? Why not let me try Menopur, or HCG instead of only giving me one option: Testosterone?
I decided at first to say F*&^ YOU to the insurance companies and just pay for HCG out of my own pocket. I’ve read a lot about using HCG for hormone replacement and I like the idea that I could stop at any time and still have working testes (providing I don’t go higher than about 500 IU 3x per week, above which the leydig cells can become desensitized to FSH and LH). So I got the doctor to prescribe me HCG. First, he doesn’t want to do less than 1,000 IU per injection, and no less than 3 injections per week. Good grief. Did you read the part in the parentheses?
OK, I was willing to work with the guy and let them give me 1,000 IU for a few weeks, then tell him to give me an E2 test and use that as evidence for him to reduce the doses since my E2 would probably be sky high. BUT…
Then it turns out that they are going to charge me $40 for every shot (not the medication, mind you, just the activity of injecting me) which would be $480 a month! Just for them to inject me!?!?! So I asked if I could inject myself at home. This way, not only could I reduce my dosage, but I could actually AFFORD to take this stuff. But noooooooo, they just can’t do that. Why? Because. What if I take a class on injecting safely? No.
So now what? Now I’m going to have to go with one of these compounding pharmacies out there. A few of them are legit alternative resources. But many more of them are very shady and could be mixing up “dirty” medicine that could give me a major infection, at worst, or maybe even giving me under/over dosed medication, or no medication at all, or the wrong medication…. I am being FORCED to go underground to treat a legitimate health issue.
FUCKFUCKFUCKFUCK FUCKITY FUCK FUCK!
Excuse my language. I hate the healthcare system here. I really do.
4 thought on “Doc Says NO to Self-Administered HCG. Insurance says NO to Menopur and HCG”
Get a different endo dr…My perscribed me hcg at 9,000 iu per wk…U need that much to get jumpstarted….If you do any less, your probably waisting your time. read into dr scallys pct. It helps guys get off trt that have been on for years! There is a protocol that combines hcg, nolva, and clomid to fully recovery natty test levels!
My husband was diagnosed with secondary hypogonadism in 2005 by Dr. Walter Schwartz of Springfield, PA. The diagnosis was confirmed with a Clomid test, wherein my husband’s Testosterone level was checked, Clomid was then administered, and “T” level rechecked. T level before test was 225 ng/dL (lab reference 241-827); after, 525 ng/dL. This doctor prescribed a routine of Clomid and Arimidex, with a rest period once each month due to teh fact, as he explained, that Clomid is a pretty heavy-duty drug and not intended for long-term useIn the following months. Follow-up T levels were done over the next few months at about 30-40 day intervals, with the following results: 930, 736, 724, 680, 598, 526. We were worried about the Clomid, because it apparently it is pretty heavy-duty; the doctor took my husband off it near the end of 2005. So, early in 2006, we made an appointment with someone else we’d read about, Adrian Dobs, M.C., M.H.S., a professor of medicine and oncology at Johns Hopkins in Baltimore who has served on conferences on andropause. This was a mistake. She had my husband do a preliminary blood T level, which was the 526 reading above, stated he was “normal” despite his many complaints related to very low Test, including a relatively short but very worrisome diagnosis of depression (treated briefly by counseling and an anti-depressant), and despite knowing the 526 blood Test was due to the Clomid treatment. Before she would do any other testing, including an MRI of his hypothalamus-pituitary, she told us he had to stop taking everything he was taking (vitamins, supplements including zinc and saw palmetto) for 4 entire months to cleanse his body, and only then would she consider seeing him again for possible treatment. We’d had to schedule the appointment nearly 5 months in advance, had placed great hopes we would truly know what my husband’s underlying dysfunction was, only to leave Baltimore practically in tears from the disappointent. Ok, then we located Dr. Eugene Shippen of Shillington, PA, author of The Testosterone Syndrome. This is an older book, but Dr. Shippen is remarkable. The book is easily available for purchase thru the web and discusses both primary and secondary hypogonadism. He does not accept insurance. However, the money we spent for the thorough workup he does was well worth it. He first ordered lab testing (not just reproductive hormones, but the lipid panels, glucose, etc. that you would also get done at a yearly checkup), so that he would have the report by the time of our first visit. Ultimately, he agreed my husband suffered from secondary hypogonadism. He prescribed HCG, injected, and also explained that learning to inject at home was easy. Although Dr. Shippen does not accept insurance, we were able to submit his office visit bill to my insurance carrier, who paid it minus the co-pay and up to the limit for a consultation visit, and my insurance has also paid every lab done since that time (sometimes several a year) and has paid all but the co-pay on the HCG. We primarily use a brand name HCG called Novarel.It can be hard to find at local pharmacies, so eventually I went to the source (the manufacturer) and learned that it is made from menopausal women’s urine and is therefore hard to come by, and that they try to ensure that only those with true medical diagnoses (such as secondary hypo) get it. In addition, HCG is more natural than Clomid and does not carry the same risks. However, I do say this with just a bit of caution now, having seen on your website that HCG can result in eventual desensitization fo the Leydig cells. This sounds similar to what happens to adult-onset diabetics who have regularly overloaded their insulin receptors and are so surprised when the receptors get worn out.
At any rate, the HCG has worked remarkably well, with one important caveat. My husband was about 40-41 years old when we first noticed his symptoms (tired, seriously decreased or absence of sex drive, not as interested in working out — which he has done regularly since high school — weight gain, anger episodes — from a very laid-back and calm person). We had seen about 5 doctors locally before we found Dr. Schwartz in Springfield, and then eventually Dr. Shippen in Shillington, PA, starting in 2005 and 2006, when my husband was 44-45. He is now 51. During the first couple of years on HCG, the results were excellent, but would occasionally drop a bit, then return to good again. However, in early 2010, his T level again dropped low, to 376, and subsequent tests in early 2011 read 336 and 259. It was time for our annual visit to Dr. Shippen, and he said it was very possible that the HCG would begin to lose its effectiveness because my husband would begin going through regular male menopause (andropause), where his testes would no longer be able to respond as well to the HCG and would likely begin a slow decline in testosterone production, the same as with many other men. He suggested that my husband begin actual testosterone replacement, but continue HCG on a twice-weekly basis to ensure his testes did not atrophy. We were aware that exongenous testosterone would likely depress his own natural test production via the HCG stimulus, but as you know, secondary hypo has not been well researched as to root causes and possible “fixes,” so this was probably our only alternative. He began treatment with .7 mg testosterone (mixed by a compounding pharmacy into an oil and applied topically), along with DHEA/Testosterone applied similarly. This helped quite a bit, with his T level going from a low of 191 on 8/1/11 to 775 and 756 30 and 60 days later. However, his latest lab was 997 Test with an estrogen reading of 78.1 (lab reference range up to 42.6 maximum). So things went well for a couple of months, until these most recent labs. He felt absolutely great through mid-August into mid-December, and then began to feel just a little depleted, and sure enough, the 1/16/12 lab quoted above showed his test was probably too high and perhaps converting too much to estrogen.
So, Dr. Shippen is having him tweak things again, but it may just be that–as you describe–the exongenous Testosterone has drawbacks. And, of course, my husband seems to be a male who runs high on estrogen conversion. He usually feels best with T levels around 650-750 and with whatever estrogen level accompanies those T levels (ranging from a ratio of anywhere from .50 to .80 estrogen to testosterone).
So, our insurance company does pay. Perhaps because we were able to get a bona-fide diagnosis, or perhaps because our insurance company is a good one (Blue Cross Blue Shield of Delaware)? I’m not sure about this, but I do know I have had to do a lot of talking and faxing documentation from time to time. Once established, however, we have not had a problem with either up-front coverage or reimbursement.
In the meantime, your blog is very helpful because it offers answers to men who don’t have the type of testosterone dysfunction that is all over the TV and can be assisted by Viagara, Cialis, Androgel, or the like. Because there are men who have secondary hypogonadism, they need to know that the newer treatments for “andropause” may not help them at all and could even make things worse.
Debora thank you for the detailed response. I’m sure some of our readers will find it very helpful. The challenge of balancing an optimal testosterone range without going over the limit and converting to estrogen is something we all deal with, and it isn’t an easy problem. In my opinion as a patient who has used HCG, Gels, Injectibles, Clomid, Arimixex and several other medications – injectible testosterone in the form of Enanthate or Cypionate once per week intramuscularly is the best solution for steady levels over time and minimal aromatization into estrogen. I have read, though can’t say how true it is, that topical applications convert to estrogen at a higher rate than when testosterone is injected. The logic behind these claims is that the skin and fatty tissue below has more estrogen receptors and/or aromatase enzymes.
I wish you and your husband luck in your journey to long-term wellness.
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